Plantar Fasciitis & Heel Spurs

What is it?

The plantar fascia is a tough membrane that is the continuation of the Achilles tendon, the common attachment of the calf muscles to the calcaneus (heel bone). The plantar fascia travels along with the bottom (plantar) surface of the foot. It’s almost as wide as the bottom of the foot and extends all the way to the balls of the foot where the toes begin, attaching to many bones along the way. The “-itis” in the name implies that there is inflammation of this tough tissue, which helps to maintain the arch of the foot along with a number of tendons and small muscles.

Heel spurs are small, boney outgrowths on the bottom of the heel bone. These form when the plantar fascia pulls excessively on the bone. While most heel spurs are not painful, a pin point tenderness may occur around a heel spur.

What are the symptoms?

The classic symptom of plantar fasciitis and symptomatic heel spurs is pain with the first step out of bed in the morning. The pain is sharp and usually begins at the heel and travels along the bottom of the foot. It also occurs after prolonged sitting or rest, since the plantar fascia shortens while not weight-bearing and the inflammation accumulates around the tissue.

What causes it?

Plantar fasciitis can occur as an acute injury, usually during a sudden increase in activity such as running, walking or sports. The classic cause is “too much too soon”.

Chronic plantar fasciitis is also related to biomechanical foot problems with, or in the absence of, a sudden increase in activity. Chronic plantar fasciitis may result in a bone spur, but only after several months of inflammation and pulling on the fascia.

When the rear foot (calcaneus) overpronates, and/or the forefoot (front) overpronates (dropped arch), the plantar fascia is pulled and stressed with every step. If the biomechanical, overpronation is not corrected the inflammation will continue.

How is it treated?

The first objective of treatment is to control the pain and inflammation. This is usually achieved through ice therapy and modalities such as ultrasound or laser therapy.

Once the pain and inflammation have been reduced, you can gently begin stretching the calf muscles and Achilles tendon, holding each stretch for 30-60 seconds. While this is helpful, it doesn’t address the cause of the problem if over-pronation is involved. A custom orthotic will address the specific biomechanical needs of each foot, the right and left foot usually have different needs. A quality shoe is also necessary for proper shock absorption.